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Ethiopia. Unlocking the confines of Illness. pMTCT Project Fekadu Chala Dabi, Christine Groff Nadia Nijim, Rebecca Noe, Cynthia Pearson. Ethiopia. A Regional Glance: Population. A Regional Glance: GDP per Capita. Health System Structure. Budget $ 150 million US ~ 1.7% of GDP

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Ethiopia l.jpg

Ethiopia

Unlocking the confines of Illness

pMTCT Project

Fekadu Chala Dabi, Christine Groff

Nadia Nijim, Rebecca Noe, Cynthia Pearson


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Ethiopia


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A Regional Glance: Population


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A Regional Glance: GDP per Capita


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Health System Structure

  • Budget $150 million US ~ 1.7% of GDP

  • 3 medical schools train 200 doctors a year, but highest rate of brain drain in Africa

  • Physician to population ratio: 1 : 38,619

  • Health care facility to population is 1:172,000

    • Health stations 1 : 27,456 persons

    • Hospitals 1 : 658,305 persons


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Basic Health Determinants


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Ethiopia and HIV/AIDS

  • 2,100,000 Ethiopian living with HIV/AIDS

    • 52% women; 38% men; 10% children

  • 6.4% HIV/AIDS prevalence

    • Urban 13.7% rural 3.7%

  • 87 % of all HIV/AIDS infections result from hetero-sexual transmission.

  • 990,000 estimated orphans

Sources:UNAIDS,U.S.Census Bureau 7/2002


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Ethiopia


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The City: Nazret

  • Capital city of the largest region - Oromia

    • Population: 130,000

  • Worst health conditions in Ethiopia

  • 75% of the endemic disease are communicable

    • Respiratory, Diarrhoeal

    • Malaria/TB

    • STI/HIV/AIDS


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Legend

Church School

Mosque

Pharmacy

FGAE

Hospital/MOH

Factory

Clinic

Health Structure of Nazret

Unpaved roads

Railroad

Highway


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Major pMTCT Interventions

  • Improved Maternal Child Health (MCH) Services

  • Voluntary Counseling & Testing (VCT)

  • Safe infant-feeding choices

  • Safe Motherhood practices

  • Antiretroviral drugs (ARV): Nevirapine

    http://www.coregroup.org/working_groups/hiv_resource_materials.pdf


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Project Objectives

1. Offer voluntary counseling and STI testing (VCT) to all (100%) women who are receiving antenatal care (ANC).

2. Increase the acceptance of VCT from 50% to 80% of ANC participant.

3. Increase acceptance/delivery of nevirapine from 20% to 80% of HIV infected mothers who received ANC and who have accepted VCT.


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Community Partners

  • Provision of VCT and pMTCT

    • MOH hospital, 3 private clinics, 1 RH clinic

  • Training and program implementation

    • Family Guidance Association

  • Community groups for follow-up support:

    • 3 religious groups (2 Christian, 1 Muslim)

    • 4 NGOs

    • 1 PLWA group

    • 1 women/mother’s support group, and

    • 1 youth group


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Input: Time - 3-year program

  • Training: VCT counselors – 2 weeks

    Clinics: ARV – 3 days

  • 1-day refresher training every 6-months

  • Training for replacement VCT counselors and clinic staff

  • Bi-weekly visits by VCT and pMTCT trainers and supervisors (later monthly)

  • Every 3 months overall project meeting


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Input: Staff

  • Trainer of trainers - 1

  • Trainers: 2 VCT; 2 clinic pMTCT

  • Project coordinator: 1

  • Supervisors: 1 VCT; 1 pMTCT

  • VCT staff: 6 (2-hospital, 1-RH clinic, 3-private clinic)

  • pMTCT clinic staff (~14) doctors, nurses, midwifes


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Input: Other Resources

  • Funding

  • Training materials (rooms, lunch, supplies, kits)

  • VCT and pMTCT guideline manuals for all participants

  • Space to ensure VCT can be provided and will be confidential

  • Supply of HIV rapid test kits, Nevirapine

    • 6 months inventory maintained on hand at local hospital warehouse


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Present Model of VCTService Delivery

Pre-test counseling

Testing

(as desired by the client and after informed consent is provided

Post-test counseling

(more than one visit if needed)

Individual risk assessment & risk reduction planning


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Model for Nevirapine Delivery

  • Sustainable HIV kits/drug supply

  • Strengthen delivery infrastructure

  • Nevirapine HIV+ pregnant women

    • To women at the onset of labor: 200mg

    • To baby within 72 hrs. of delivery: 2mg/kg body weight


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Process (1)

  • Develop plan: initial training manuals

  • Train VCT counselors and pMTCT clinic staff

  • Monitor quality of training and quality of teaching

  • Teach trainees to use the manual as a resource

  • Initial follow-up: bi-weekly trainee meeting to discuss barriers/problems


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Process (2)

  • After 6 month in field – secondary training

  • Ongoing support and feedback

  • Monthly site visits by supervisors

  • Monthly reports from project supervisors to coordinator

  • Consumer satisfaction feedback


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Outputs and Outcomes:

  • Trained 6 VCT counselors; 14 clinic staff in pMTCT

  • Track quality

    • Pre-post-test

      • % Increase in knowledge

      • Areas to improve curriculum

    • Focus groups at 6-month training

  • Availability of HIV test/Nevirapine

    • % Of time in 3 years with no shortage of HIV test kits or Nevirapine


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Outputs and Outcomes: (2)

  • Use of pre-test counseling:

    • % of women who received counseling [initial use]

  • Use of HIV testing/post-counseling:

    • % of women who received HIV testing during pregnancy [Measures initial use &continuity]

  • Use of Nevirapine:

    • % of women who HIV+ and request treatment and receive course [measures continuity of service]


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VCT/ARV Impact

  • 100% ANC participants offered VCT

  • 80% acceptance of VCT services

  • 100% of HIV + women identified through VCT will have access to Nevirapine

  • 80% of these (HIV + mothers & newborn) will complete Nevirapine regimen.


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Amesegnalehu

(Thank you for your attention)


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